Abstract
A 79-year-old male was admitted with abdominal pain and consciousness disturbance, and was in shock on arrival. Laboratory data showed renal failure, liver damage, elevated serum amylase level, bleeding tendency and severe metabolic acidosis. Radiological findings failed to reveal the cause of his shock. He was initially diagnosed as having hypovolemic shock and was treated as for acute pancreatitis. Despite this therapy, he developed disseminated intravascular coagulation and died approximately 8-hours after admission. Sputum and blood culture revealed no organisms, but a rapid urinary antigen detection kit for Streptococcus pneumoniae (NOW Streptococcus pneumoniae, Binax Inc., USA) was positive. Because this test shows high specificity and has a low false positive rate, he was finally diagnosed as having suffered septic shock due to Streptococcus pneumoniae. Fulminant pneumococcal infection doesn't always initially develop pneumonia, so we should consider fulminant pneumococcal infections when examining unexplained severe sepsis and septic shock regardless of findings related to pneumonia. In such cases the diagnosis depends on blood culture, but this doesn't show good sensitivity or swiftness. Our case suggests the usefulness of a rapid urinary antigen detection kit for Streptococcus pneumoniae for early diagnosis of fulminant pneumococcal infection when there is a negative blood culture.
